Do I Have To Do the Full AIP?

About Dr. Sarah Ballantyne, PhD

Award-winning public speaker, New York Times bestselling author and world-renowned health expert, Dr. Sarah Ballantyne, PhD (aka The Paleo Mom) believes the key to reversing the current epidemics of chronic disease is scientific literacy. She creates educational resources to help people regain their health through diet and lifestyle choices informed by the most current evidenced-based scientific research.

The autoimmune protocol of the Paleo diet (AIP) is very effective at addressing autoimmune disease (and related conditions like allergies and non-autoimmune skin conditions) and for identifying food sensitivities. It is an elimination diet which restricts all of the most common food allergens/sensitivities as well as foods containing substances known to prime the immune system (like nightshades). If you combine this approach with food sensitivity testing, it’s even more powerful at addressing a huge variety of health conditions. However, it is really hard. It can feel very restrictive for those of us who have been following a Paleo diet for a while; and for those completely new to Paleo, it can be completely overwhelming.

I get asked the question frequently: “do I have to follow the full AIP?”. I also get asked “does it matter if you cheat/fall off the wagon on the AIP?” and “Isn’t it easier to just get tested for food sensitivities?”. Let me try and answer these questions one by one.

I believe that following the full autoimmune protocol is the most expedient way to address autoimmune disease and identify food sensitivities. However, it only works if you can stick to it! If it is simply not possible for lifestyle, budget or psychological reasons to follow the full autoimmune protocol 100% strictly, you can try to limit a couple of the food categories instead of all of them. I have explained many of the whys behind the various restrictions in the autoimmune protocol (see this page for a list) and you can use these posts (and your personal history) as a general guide for prioritizing what foods you omit from your diet. As a basic starting point, I would highly recommend at the very least omitting nightshades from your diet. Egg whites would be the next most likely culprit, in my opinion. This may be an iterative process for you. Instead of jumping in with both feet, you can try omitting nightshades, see how you do, add in the omission of egg whites, see how you do, omit whole eggs, nuts and seeds, see how you do… The full throttle, cold turkey approach works well for some and, for those who can pull it off, is more likely to yield fast and dramatic improvement in symptom. But it isn’t for everyone; and it doesn’t need to be.

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If you are new to Paleo, you may find great relief of your symptoms with a standard Paleo diet, so it is definitely worth trying that first before tackling the challenge of the autoimmune protocol. It can take a while to get used to this way of eating, depending on how you ate before, both in terms of figuring out where to buy quality ingredients and how to cook them, and also in terms of resetting some basic assumptions about what meals should look like. You may have to reprogram your basic responses to food; for example, you may need to stop reflexively recoiling from high fat foods in fear that they will make you fat and cause heart disease. You might have to let go of the concept of “healthy whole grains” or that you need to drink milk for healthy bones. You might have to get over your fear of organ meat. You might have to get used to cooking more often. And your body may go through a sluggish, cravings-filled adjustment period as it adapts to a lower carbohydrate/sugar diet. After a month or two of a regular Paleo diet, once you feel like you have adjusted and it doesn’t seem in itself to be so overwhelming, then you can evaluate whether additional dietary restrictions may be helpful for you. However, I do need to add that if you are really struggling with disease, you might consider adopting a nightshade-free Paleo diet from the start and try to find alternatives to eggs for breakfast that work for you.

Does it matter if you cheat on the AIP or fall off the wagon temporarily? Well, the answer to this is “it depends”. It depends on what you cheat with, how much you eat, how often you cheat, and what your specific health conditions and food sensitivities are. I think it’s very important not to eat any of the basic Paleo diet restricted foods. This means absolutely no grains (and especially especially no gluten-containing grains), absolutely no legumes (especially especially soy and peanuts), and I urge strong caution with dairy (especially pasteurized conventional dairy). You can try some grass-fed butter or ghee and see how you do, but it would be better to omit dairy completely at least for a few weeks. Refined sugars and processed food chemicals may also cause a shockingly strong reaction, especially once you’ve been following a Paleo diet for a while. As for the AIP-restricted foods: tomatoes have the ability to rev the immune system so alarmingly that it can take months to calm it back down again. Other nightshades can have similar effects, although maybe not as dramatically as tomatoes. Egg white proteins can act as carrier molecules to bring proteins that activate the immune system across the lining of the gut, which is especially a problem if you are reacting to bacterial proteins from your gut microflora. And any food that you have a food sensitivity to will cause an exaggerated response (in my case, that’s almonds). But as for a little bit of wine, a small handful of nuts, a square of dark chocolate, egg yolks, a sweet potato, a coconut-flour pancake with maple syrup? You might tolerate those things. Even if you don’t tolerate them, they may only set you back a little. Of course, they might be disastrous. The trick is to find a balance between what your body will tolerate and what it needs to heal. This needs to be sustainable for you so you adhere to the protocol as strictly as is possible. If that means allowing yourself a little dark chocolate (and providing you don’t react very strongly to dark chocolate), then that makes a whole lot of sense. Will completely falling off the wagon for a couple of days set you back to ground zero? It might or it might not. It is certainly an opportunity to reevaluate what you need to change to make this work for you so that you can have success at addressing your health conditions.

Is it easier to just get tested for food allergies and sensitivities? Well, it is and it isn’t. Some people will have food sensitivities to foods that are allowed on the AIP. In this case, even following the AIP 100% will not be sufficient to see substantial alleviation of your symptoms (and I have a whole post about this coming soon). In the case of nightshades, eggs, caffeine and alcohol (and NSAIDS, even though they aren’t a food), they can be problematic in a way that is not a food allergy or sensitivity, so you will very likely have to try an elimination diet strategy with those foods anyway. Food sensitivity testing also won’t tell you if starchy vegetables are feeding Small Intestinal Bacterial Overgrowth or if you have a FODMAP-sensitivity. However, if getting food sensitivity testing done is within your budget, then I definitely recommend it as the information will still be very useful for you. Also, if you continue to have issues after following the AIP very strictly for several months, food sensitivity testing may help you find the missing link. However, not all foods are tested for and some sensitivities may still be missed. In this case, you may wish to work with a naturopathic physician or nutrition-savvy physician or chiropractor to do an even stricter elimination diet approach to narrow in on the culprits.

So, do you need to do the full AIP? I think that following the AIP strictly for at least a couple of months is the fastest way to see improvement in your symptoms. But no, it is not completely necessary and there other ways to approach disease management and identification of food sensitivities. Just like everything else in the Paleo world, this is individual and you need to find what works for you.

Reader Interactions

Comments

Hi Sarah, I have been trying to follow the AIP for for several weeks now but keep slipping up on the nightshades (occasional tomato in a salad eating out and pepper seasonings). I had nuts (tahini) once but no eggs or grass fed butter. In my pre-Paleo life the only thing on this list that I have a severe reaction to is NSAIDS…oddly enough they caused my scalp to itch HORRIBLY and I end up feeling very out of it and like I can’t even think straight. Can you tell me how NSAIDS relate to the rest of these foods. Now that I think of it I do think I had a hive reaction to tomatoes when I was young and have only just begun to eat them as an adult over the past few years. I have never had a problem with nuts or eggs…I am starting to think that I might bring those back and focus all of my energy on nightshades and see if I notice a difference. Just wondering if there is a connection between NSAIDS and nightshades?? Thanks!

I’m not sure if there is a connection between NSAIDs and nightshades, but NSAIDS do increase intestinal permeability, particularly in the duodenum (this is how they are absorbed). The duodenum is the first segment of the small intestine, so it has the most undigested food particles in it to potentially cause problems if they leak across. My autoimmune issues all started when I was taking large amounts of ibuprofen for headaches. I’m sure I had lots of other bad things going on at the time, but I suspect that had a lot to do with it. I will be writing a whole post about NSAIDS and autoimmunity soon.

They are okay, except for people with SIBO. If you have any bloating, gas, heartburn, constipation, or diarrhea, then starchy vegetables might be the culprit. I typically advise that people try them and see how they do.

Dear Sarah, I started with the AIP one month ago and I felt great, but I had a cup of coffee last week and I had headaches. I want to follow the AIP and I know I need my time to be able to avoid any cheat; it’s quite difficult to follow the AIP while you go out with other people and you have to eat in restaurants! This weekend I tried a very small amount of diary and an egg. Now, I feel suffocation (I think it`s the right word, I’m not an English speaker, I mean I can`t breathe deeply and it’s like I can’t get air) and my bellie is swollen. Are these symptoms of food sensivities? Why are the nightsades the first group of foods we should avoid? And thank you for your blog: It’s great and it’s helping me with my Hashimoto condition. Thanks again!

Yes, these can be symptoms of food sensitivities. I recommend nightshades as the most important to avoid because the glycoalkaloids in them can exaggerate immune reactions (this happens even if you are not sensitive to them). I know that it’s tough to follow the AIP. Hang in there!

Thanks, Sarah! I’ve heard they loose their glycoalkaloids level when cooked, but I guess that even then we should avoid them. I’d like to ask you one more question: I think I read that macadamia nuts are ok for the AIP, in one of your posts. Am I ok? If so, why are they allowed? Thanks again!!

Nuts are a common food sensitivity, so it’s best to try some time without them first. But then, macadamias are probably the best nut to try adding back in first (they have mostly monounsaturated fat and are relatively low in phytic acid). I personally do better with macadamias than any other nut.

I haven’t put together meal plans, except for post about what I eat for breakfast. I get carbs from veggies and some fruit. I’m okay with small amoun of starchy vegetables, but still stick mostly with non starchy. I would say I get 75-100g per day, so I’m not really low carb.

This question might be redundant but I am wondering about this modification and Multiple Sclerosis. I have no symptoms, you discuss people knowing they are healed persay when they notice they are symptom free, (I have had a few but they were/are years apart and minor, I am currently symptom free (which makes me feel incredibly blessed)). My question is, if I have had an alyssa food allergy test and am following a Paleo diet also excluding eggs as well as my other allergins must I also give up all the possible offending foods even though my blood serum showed no reaction? Or, because I am allergic to some seeds, some nightshades, most nuts, do you feel it would benefit me to also give up all of the foods in those categories? Because I am symptom free it is incredibly hard to implement these changes for any other reason than what might be, and I am having a hard time even making that be enough.

It can be very difficult to sort out which foods are culprits if there’s more than one when you eliminate one by one. Some people are able to do this with great success though, so it’s worth trying if you think that would be more manageable for you.

Thank you for the great article! I’ve tried AIP a few times but never lasted long before I’d fail! This time I did two months of Paleo first (no sugars, nuts and rare fruit), read up and have a better plan and will follow through for a super strict 60 day elimination phase before following your guide to slowly reintroducing. I’ve got a lot of healing to do but had to be mentally/emotionally prepared as well! Love your blog and waiting for your preordered cookbook! You’re such a help to many! Thank you! I was wondering if you could answer something on strict AIP for me? I have two jars of Bubbies dill pickles, unopened. The spices in the jar are not AIP. I had been eating the pickles and drinking the juice, a little each day before re embarking on strict AIP…..I wanted to ask you, the expert though if its safe to eat just the pickle and no juice or would it be best to just give them to my parents?

Sarah recommends following a strict version of the AIP for thirty days. If you truly want to follow the strict AIP, then you would not eat the pickles or drink the juice. Preparation for following the AIP and food reintroduction is discussed in detail in The Paleo Approach. You may want to join The Paleo Approach Community group on Facebook, request to join here: https://www.facebook.com/groups/TPACommunity/ — Tamar, Sarah’s assistant

So, I’m thinking about trying AIP for acne reasons. I know its very hormone related (it’s mostly found on my chin and spreads up my face. I want to minimize inflammatory foods and test for food sensitivities (I’ve been very dependent on nuts, seeds and eggs lately and I’m worried they may be a culprit.

My question is: is it best to cut out ALL seed related foods simultaneously? Or can I do a test with most seeds (including cocoa) and save coffee for another time? I tried to do them all, but it was pretty overwhelming losing both my favorite comfort drinks at the same time (tea and chicory are just not the same). Am I sabotaging myself or is this good enough?

You don’t have to cut out all those foods at once, but you do need to see improvement in your health (which usually means following the strict AIP and may also entail some troubleshooting if you don’t see results within 30-90 days) before you add any foods back in. – Christina, Sarah’s assistant

Hi, I just got your book a couple of weeks ago and have been following AIP ever since. However I am faced with a dilemma, with regards to NSAIDs. I only take Advil once a month (though usually a few doses) for my menstrual cramps. They are very painful and I find myself in bed all day if I don’t take anything. How deterimental to my healing might this be? I’m lucky to not need pain medication all the time, but one day a month I find I really do. I’m wondering if it would be disastrous or something I could recover from, to take some Advil once a month. Thanks for all your great work! I’m hopeful that I will be able to get through my periods without Advil someday.

It took a couple months to make the full transition but I am now full AIP, and introducing foods back one at a time. It is very sad that none of the foods I introduce back in want to be acceptable lol. But I will gladly stick with the AIP, it is totally worth it to not experience the kind of pain I was living in every day. I can’t imagine how many people are walking around with chronic and debilitating health issues who cant seem to make the connection between diet and health. And how totally ignorant most doctors are about it all.

Hi Sarah, thank you so much for all your work. I’ve just got your book and am phasing into AIP. (And I’m giving your book to two friends for Christmas! Spreading the word.)

About a year ago, just after I was diagnosed with an AI condition, I had a FACT test – (Food Allergen Cellular Test) – ‘measures the release of inflammatory markers from white blood cells following exposure to the test foods and additives for the assessment of both IgE and non IgE dependent allergic reactions’. I passed with flying colours, not a single food showed a reaction. Does this mean I needn’t be so strict doing AIP? It’s the nuts and seeds I find the hardest to give up.

Also, may I ask, do I have to wait until I’m off steroids before reintroducing anything? That will take 8 months or so, which seems like an awfully long time…

thank you for this timely post. I am having a sad day. For the last year, I have been in pain. Hadn’t had a flare for 6 years. Been GF/DF for almost 7 years. I learned about cyrex labs Gluten cross reactivity test and environmental sensitivity tests and finally had some hope for some answers. Got results today. The only new thing that came back was a slight reaction to soy and benzene/heavy metals. I am glad, but crushed to not have a more glaring answer. I do take NSAIDS when I travel (meloxicam) and occasionally for headaches. I will be interested in reading your post about those. Does anyone know of environmental testing available for homes? Thank you for all you do.

I thought I was following the AIP well, but through my own fault, have been exposing myself to some nightshade spices and dairy. I have been on this for 14 days. Were my efforts in vain? Did my gut heal at all? I’m thinking of having a glass of wine tonight and starting fresh in the morning. It’s really hard and I thought I was doing great, until closer inspection revealed I wasn’t.

Dear Sarah I have been on AIP for two months, but somehow I do not get enough carbs. I am sensitive to coconut and to sweet potatoes, have not found something like chest nut flower yet. Since I have a problem with glucose, I cannot eat too much fruit. I know that the root vegetable are starchy, but this is not enough. After a proper meal made of meat and let say a huge salad I still feel hungry for a while and then get terrible headaches and my eyesight is blurred. So I decided that I need some kind of other carbs. Was thinking about chinoa or white rice or should it better be some legumes, or potatoes? I just need something which would be less harmful. Cannot go on like this, it is doing me more harm than good

This is extremely interesting information – thank you. I am not sure if/how it may apply to my child; perhaps you can help? My son is now four years old and was diagnosed at 18 months with Type 1 Diabetes. He is growing well, has no other medical conditions (that we know of) and is generally a happy child. He has been following a gluten and grain-free diet since March of this year and this is working well for him. I do not know if he has a gluten sensitivity or if he has a leaky gut, I just decided that it would be wise to avoid these foods for better blood glucose regulation and to let his gut heal if it needs to. But now we get to the AIP: sadly, we cannot reverse his Type 1 diabetes but I am keen to avoid ANYTHING that may trigger an additional autoimmune disease! However, when a person has T1 diabetes, how do you go about this? I gather from my reading that the AIP is a diet that is followed strictly for a relatively short time and that foods are then reintroduced slowly while checking for adverse reactions. But when you have Type 1 diabetes and no other disease symptoms, how can you assess if you have any food sensitivities? Will avoiding foods listed on the AIP aid in preventing him from getting other AI diseases or is this a step too far? I feel I cannot exclude eggs and nuts and seeds and nightshades, etc. from his diet as he already has restrictions on many other foods due to the effects on blood sugar. And yet I feel anxious every time he eats these foods simply because I know they are on ‘the list’!! Please advise. Do I keep on feeding him a gluten-free diet, keeping off grains and hope that he doesn’t succumb to another AI disease? Or do I go extreme and try to stick to the AIP and potentially starve my child of all sorts of nutrients and make life very difficult? I certainly don’t think I could do this forever. Or do I avoid the worst culprits, e.g. tomatoes? Or is that totally unnecessary unless he gets another AI disease. Please advise… this is a daily source of worry for me and, like most parents, I want to protect my child, whatever it takes. Thank you.

I am currently taking some plant based supplements that include some sugar, stevia and even rice flour. I have had great results with health issues from these but I am curious will they affect the results I get from doing a strict AIP? I do not want to stop them if I do not have to, I am loving what they do for me, but I had not realized they had some small amounts of these things in them. Thank you!

Coconut flour is a perfectly appropriate flour to use on the AIP diet. However, consuming large amounts of baked goods made with coconut flour, even if they’re AIP friendly, is not ideal as far as giving your body the nutrients it needs to heal. -Kiersten

Hi.. I have questions with the aip and breastfeeding.. I have autoimmune Lyme and autoimmune thyroid at least.. I have the genes for celiac but not confirmed if I have celiac.. my health is very poor. Im pretty much on bed rest.. the worse of my problems started over 2 years ago when i had a severe postpartum hemorrhage letting the Lyme really get a hold of me.. we were trying everything supplement and diet wise for me to heal before and after we knew of the Lyme… Went on the 40 day makers diet and my milk dried up with it only being 3 month postpartum after only a few days of the diet.. i was able to get it back with lots of nursing and herbs but could never stop taking the herbs… Anyways many lab test… Naturopaths.. supplements… Doctors.. nutritionist.. and months later found out I had Lyme and was pregnant again and had not recovered.. went on gaps to heal leaky gut.. very strict.. no grain.. sugars.. Fruit.. starchy veggies… Raw veggies… Dairy (except raw goat milk) … Nuts.. legumes… With absolutely no change at all in any health issue or digestive problems.. I was still having pain to even take pills and all solid food.. dr finally wanted me on beginning gaps liquid only.. did let me have grass fed A2 raw milk and homemade yogurt 1 tablespoon of raw honey and broth.. that’s after 4 days of that (remember I’m pregnant and also breastfeeding) I couldn’t do it any more… After doing some things for H pylori I got where I could handle solids.. anyways health never changed and after having this baby got severe postpartum anxiety and depression.. then found out about the thyroid autoimmunity.. so looking at aip.. Dr wanted food tolerance test and comprehensive stool analysis.. ordered a 180 food finger prick.. concerned about doing aip while breastfeeding.. do you have an opinion? I’m wanting some relief from symptoms but afraid of the affect on my supply and the nutrients and that I haven’t had any change in health condition.. I stayed off grain the whole pregnancy except a very few times of sour dough.. and only Stevia and raw honey.. once I stopped the gaps extreme… Pretty much stayed on full gaps since.. with addition of a2 milk.. which I feel good when I have it.. much better than solid food anyways.. did see on your site if you know a food doesn’t hurt you like grass fed milk you can have it.. how do you consider it that you know? I do know the raw a2 grass fed does not bloat or give me any problem that I know of that pasteurized or some other grass fed milk (I assume a1) does…

I was thinking the food tolerance would be a better way to go. But confused.. thanks for any help..

Thank you for putting so much faith in us! Since your case is so complicated, we really need to recommend that you continue to work with a physician. Best of luck, and keep us updated! -Katie, Sarah’s Research Assistant

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